Pressure ulcers are among the most common ulcers that occur in hospitals, nursing homes and in those who have limited mobility. They are associated with increased risk of infection, pain, and even death.
Many of these ulcers are preventable (not all) and it is important to understand the risks factors for these ulcers and what preventive measures can be implemented by patients and caregivers to minimize their risk. Treatment of these ulcers requires a very broad holistic approach to care that is patient centered and consistent with goals of care.
Listen in as Dr. Kim Petrone explains that it's important for the patient and caregiver to understand their nutritional status, their offloading plan, their dressings, and benchmarks for healing. Advanced treatment modalities such as Electrical stimulation and negative pressure wound therapy can also be used to treat recalcitrant ulcers.
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Help for Pressure Ulcers
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Learn more about Kim Petrone, MD
Kim Petrone, MD
Kim Petrone, MD is board certified in internal medicine and geriatric medicine. She is also a certified wound specialist and has been the medical director of St. Anns community since 2016 and the medical director of the RGH wound healing center since it’s opening in 2013.Learn more about Kim Petrone, MD
Transcription:
Help for Pressure Ulcers
Bill Klaproth (Host): Pressure ulcers or bed sores can be very problematic for people that have prolonged pressure on the skin. Here to talk with us about pressure ulcers is Dr. Kim Petrone of Rochester Regional Health. Dr. Petrone, thank you so much for your time, today. Exactly what is a pressure ulcer?
Dr. Kim Petrone (Guest): A pressure ulcer is a sore or wound that occurs when areas of skin and soft tissue are compressed between a bone and a hard surface – or even a surface that you wouldn’t maybe consider hard, but a surface that produces pressure on the skin that is wedged between the bone and the surface.
Bill: And who is at risk then to develop pressure ulcers or bed sores?
Dr. Petrone: Most people that are aware and have good mobility and good nutrition do not develop pressure ulcers. That’s because their nutrition keeps their skin very healthy and their body senses when the skin is becoming vulnerable, and they shift position. Sometimes this isn’t even conscious to us. We just do it automatically. The people that are prone to developing these types of ulcers have issues with nutrition, so they’re at high risk for having problems with their skin at baseline. And then they may have trouble with movement or mobility. They may be paralyzed. They may have had a stroke. They may simply be so ill that they don’t have the strength to move their body, and therefore, an area of their body has pressure sustained over it for a period of time.
In addition, patients who have incontinence issues or issues where their skin becomes moist are at increased risk for developing this because the moisture weakens the skin and makes it more likely to develop these. And then finally, people that have cognitive issues. If they’re not able to move on their own and they’re not able to report the need to move or pain in a particular location, they obviously would be at increased risk as well. Folks who dementia, delirium, who may have an altered mental status due to the severity of their illness would also be at risk for developing these.
Bill: Right, so then what’s the potential impact of developing a pressure ulcer?
Dr. Petrone: Pressure ulcers are a major problem for people in nursing homes, in hospitals, and again, for folks that have mobility problems. Folks with spinal cord injuries, in particular, will have issues with these kinds of conditions. They can obviously cause pain. The area that is open and broken down can be tender or painful. They can become infected. If they become infected, they can actually cause infection in the blood stream and make people quite ill.
In addition, they can drain, so there can be dignity issues in terms of soiling clothes and soiling bed sheets. They can at times have an odor as well, so again, there’s a dignity issue with regard to that. Pressure ulcers tend to make other illnesses even more complicated to fix. When a person has a serious illness, and then they develop a pressure ulcer, the treatment becomes more complicated because now you’re treating multiple things at one time. There’s a huge push to prevent them and hopefully avoid all of those negative consequences.
Bill: Um-hum. And speaking of avoiding – are pressure ulcers avoidable? Can they improve or resolve?
Dr. Petrone: I think that the consensus is that not all pressure ulcers are avoidable. Certainly, the medical team, nursing team, and the entire team that’s caring for a patient have a huge investment in preventing as many pressure ulcers as possible. That remains at the forefront of a treatment plan always. Having said that, there are people that are so vulnerable, and so frail, and so medically ill, that a pressure ulcer is almost impossible if not impossible to prevent. Those folks would be people at the very end of life, and there is a phenomenon or a term called SCAL, which stands for Skin Changes at the End of Life. These pressure ulcers are really indicative of the skin dying along with the other organs in the patient’s body. It’s pretty impossible to prevent those or to have a treatment plan that can completely prevent those.
There has also been a paper put out by the National Pressure Ulcer Advisory Panel that suggests that there are some other pressure ulcers that may be unavoidable. Those would be people, again, that have an extreme illness, people that have very low blood pressure. Pressure ulcers, as I said at the outset, are due to the pressure that is exerted on the skin and the skin becomes wedged between the outside surface and the bone underneath the skin and soft tissues – muscle and those kinds of things.
The reason that the pressure ulcer occurs is, of course, the pressure, but what the pressure is doing is it’s occluding the very small vessels in the skin, and muscle, and tissue. You can imagine that if your blood pressure is very, very low – dangerously low – people that are in the hospital in the Intensive Care Unit or who are at the end of life – if their blood pressure gets so low that even a minor amount of pressure can occlude that blood vessel, it’s pretty hard to prevent those. There are some cases where they’re not avoidable, but again, I think the take home message is that many are avoidable and the treatment team is always looking for ways to try to keep people from developing these.
Bill: When it comes to treatment, what is that? Is that moving the person regularly?
Dr. Petrone: Correct. One of the mainstays of pressure ulcer treatment and prevention is positioning, so making sure that one area of the body does not have pressure exerted on it for a very long period of time and making sure that the pressure that is exerted is the most minimal amount of pressure that can be obtained. Positioning – people at high risk may have specialty mattresses that are either made of special materials that offload pressure or even mattresses that have air floated through them that help prevents the pressure from becoming high. The same thing with cushions for people that are seated. They have very – there’s a whole host of specialty cushions that can be utilized to try to offload pressure. There are devices for feet and heels that are similar, again aimed at trying to float the heal or float the affected area off the surface or keep the pressure minimal.
There’s positioning. There’s also maintaining very good nutrition. A lot of times people that are vulnerable to these or for folks that have already developed them, a nutrition consult is really invaluable to look at how we can get the nutrients the skin needs to heal itself back into the body, whether that be by supplements, or enhancing the person’s diet, or even if they’re having trouble swallowing, assistance at the bedside by a caregiver or evaluating what the issue is in terms of eating and drinking. And then, of course, there are issues with moisture. Anyone with incontinence issues, we’re looking at ways that we can have them on a schedule where they stay clean and dry as much as possible and using specialty undergarments that can wick moisture away from the skin.
Once a pressure ulcer has developed, there are a number of treatment modalities outside of what we’ve just talked about. They range from specialty dressings that can decrease bacterial colonization or bacteria in the wound. There are dressings that wick moisture away from the skin that keep the pressure ulcer from developing a lot of dead tissue in it. There are very advanced dressings that even use vacuum-assistance to clean out pressure ulcers and keep them healing and keeping moisture away from the skin.
There’s really a whole host of modalities. A lot of times we also use our PT and OT colleagues. For position, they sometimes have orthotics and other specialty training that can help us offload areas of the body that are prone to developing pressure. They also can utilize ultrasound and electrical stimulation, which are advanced modalities that can help heal pressure ulcers.
Bill: A lot of useful information there, Dr. Petrone. Thank you, very much. And why should someone choose Rochester Regional Health for their wound care?
Dr. Petrone: Rochester Regional Health is a state-of-the-art care center where all of our professionals are very invested in keeping people healthy and are very proactive in terms of preventing pressure ulcers. If a patient does develop an ulcer or comes in with an ulcer, we have wound care specialists both in the nursing department and in the field of physicians that can create and help execute a very comprehensive plan to treat that patient with all of the modalities we’ve already talked about.
Bill: Well, Dr. Petrone, thank you so much, for your time. Again, we really appreciate it. For more information, you can go to RochesterRegional.org, that’s RochesterRegional.org. You’re listening to Rock Your Health Radio with Rochester Regional Health. I’m Bill Klaproth. Thanks for listening.
Help for Pressure Ulcers
Bill Klaproth (Host): Pressure ulcers or bed sores can be very problematic for people that have prolonged pressure on the skin. Here to talk with us about pressure ulcers is Dr. Kim Petrone of Rochester Regional Health. Dr. Petrone, thank you so much for your time, today. Exactly what is a pressure ulcer?
Dr. Kim Petrone (Guest): A pressure ulcer is a sore or wound that occurs when areas of skin and soft tissue are compressed between a bone and a hard surface – or even a surface that you wouldn’t maybe consider hard, but a surface that produces pressure on the skin that is wedged between the bone and the surface.
Bill: And who is at risk then to develop pressure ulcers or bed sores?
Dr. Petrone: Most people that are aware and have good mobility and good nutrition do not develop pressure ulcers. That’s because their nutrition keeps their skin very healthy and their body senses when the skin is becoming vulnerable, and they shift position. Sometimes this isn’t even conscious to us. We just do it automatically. The people that are prone to developing these types of ulcers have issues with nutrition, so they’re at high risk for having problems with their skin at baseline. And then they may have trouble with movement or mobility. They may be paralyzed. They may have had a stroke. They may simply be so ill that they don’t have the strength to move their body, and therefore, an area of their body has pressure sustained over it for a period of time.
In addition, patients who have incontinence issues or issues where their skin becomes moist are at increased risk for developing this because the moisture weakens the skin and makes it more likely to develop these. And then finally, people that have cognitive issues. If they’re not able to move on their own and they’re not able to report the need to move or pain in a particular location, they obviously would be at increased risk as well. Folks who dementia, delirium, who may have an altered mental status due to the severity of their illness would also be at risk for developing these.
Bill: Right, so then what’s the potential impact of developing a pressure ulcer?
Dr. Petrone: Pressure ulcers are a major problem for people in nursing homes, in hospitals, and again, for folks that have mobility problems. Folks with spinal cord injuries, in particular, will have issues with these kinds of conditions. They can obviously cause pain. The area that is open and broken down can be tender or painful. They can become infected. If they become infected, they can actually cause infection in the blood stream and make people quite ill.
In addition, they can drain, so there can be dignity issues in terms of soiling clothes and soiling bed sheets. They can at times have an odor as well, so again, there’s a dignity issue with regard to that. Pressure ulcers tend to make other illnesses even more complicated to fix. When a person has a serious illness, and then they develop a pressure ulcer, the treatment becomes more complicated because now you’re treating multiple things at one time. There’s a huge push to prevent them and hopefully avoid all of those negative consequences.
Bill: Um-hum. And speaking of avoiding – are pressure ulcers avoidable? Can they improve or resolve?
Dr. Petrone: I think that the consensus is that not all pressure ulcers are avoidable. Certainly, the medical team, nursing team, and the entire team that’s caring for a patient have a huge investment in preventing as many pressure ulcers as possible. That remains at the forefront of a treatment plan always. Having said that, there are people that are so vulnerable, and so frail, and so medically ill, that a pressure ulcer is almost impossible if not impossible to prevent. Those folks would be people at the very end of life, and there is a phenomenon or a term called SCAL, which stands for Skin Changes at the End of Life. These pressure ulcers are really indicative of the skin dying along with the other organs in the patient’s body. It’s pretty impossible to prevent those or to have a treatment plan that can completely prevent those.
There has also been a paper put out by the National Pressure Ulcer Advisory Panel that suggests that there are some other pressure ulcers that may be unavoidable. Those would be people, again, that have an extreme illness, people that have very low blood pressure. Pressure ulcers, as I said at the outset, are due to the pressure that is exerted on the skin and the skin becomes wedged between the outside surface and the bone underneath the skin and soft tissues – muscle and those kinds of things.
The reason that the pressure ulcer occurs is, of course, the pressure, but what the pressure is doing is it’s occluding the very small vessels in the skin, and muscle, and tissue. You can imagine that if your blood pressure is very, very low – dangerously low – people that are in the hospital in the Intensive Care Unit or who are at the end of life – if their blood pressure gets so low that even a minor amount of pressure can occlude that blood vessel, it’s pretty hard to prevent those. There are some cases where they’re not avoidable, but again, I think the take home message is that many are avoidable and the treatment team is always looking for ways to try to keep people from developing these.
Bill: When it comes to treatment, what is that? Is that moving the person regularly?
Dr. Petrone: Correct. One of the mainstays of pressure ulcer treatment and prevention is positioning, so making sure that one area of the body does not have pressure exerted on it for a very long period of time and making sure that the pressure that is exerted is the most minimal amount of pressure that can be obtained. Positioning – people at high risk may have specialty mattresses that are either made of special materials that offload pressure or even mattresses that have air floated through them that help prevents the pressure from becoming high. The same thing with cushions for people that are seated. They have very – there’s a whole host of specialty cushions that can be utilized to try to offload pressure. There are devices for feet and heels that are similar, again aimed at trying to float the heal or float the affected area off the surface or keep the pressure minimal.
There’s positioning. There’s also maintaining very good nutrition. A lot of times people that are vulnerable to these or for folks that have already developed them, a nutrition consult is really invaluable to look at how we can get the nutrients the skin needs to heal itself back into the body, whether that be by supplements, or enhancing the person’s diet, or even if they’re having trouble swallowing, assistance at the bedside by a caregiver or evaluating what the issue is in terms of eating and drinking. And then, of course, there are issues with moisture. Anyone with incontinence issues, we’re looking at ways that we can have them on a schedule where they stay clean and dry as much as possible and using specialty undergarments that can wick moisture away from the skin.
Once a pressure ulcer has developed, there are a number of treatment modalities outside of what we’ve just talked about. They range from specialty dressings that can decrease bacterial colonization or bacteria in the wound. There are dressings that wick moisture away from the skin that keep the pressure ulcer from developing a lot of dead tissue in it. There are very advanced dressings that even use vacuum-assistance to clean out pressure ulcers and keep them healing and keeping moisture away from the skin.
There’s really a whole host of modalities. A lot of times we also use our PT and OT colleagues. For position, they sometimes have orthotics and other specialty training that can help us offload areas of the body that are prone to developing pressure. They also can utilize ultrasound and electrical stimulation, which are advanced modalities that can help heal pressure ulcers.
Bill: A lot of useful information there, Dr. Petrone. Thank you, very much. And why should someone choose Rochester Regional Health for their wound care?
Dr. Petrone: Rochester Regional Health is a state-of-the-art care center where all of our professionals are very invested in keeping people healthy and are very proactive in terms of preventing pressure ulcers. If a patient does develop an ulcer or comes in with an ulcer, we have wound care specialists both in the nursing department and in the field of physicians that can create and help execute a very comprehensive plan to treat that patient with all of the modalities we’ve already talked about.
Bill: Well, Dr. Petrone, thank you so much, for your time. Again, we really appreciate it. For more information, you can go to RochesterRegional.org, that’s RochesterRegional.org. You’re listening to Rock Your Health Radio with Rochester Regional Health. I’m Bill Klaproth. Thanks for listening.